Information Collection

TA Intake Assessment

IC 256532 under ICR 202210-1121-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
TA Intake Assessment	Form and Instruction
TA Intake Assessment TA Intake Assessment.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

OVC

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	TA Intake Assessment	TA Intake Assessment.pdf	none	Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 495

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	495	495
Annual IC Time Burden (Hours)	495	495
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.